08/11/14

Déjà Vu All Over Again

Leo (not his real name) walked into our outpatient clinic with a daypack over his right shoulder smelling strongly of booze. He would later show us the half-empty bottle of vodka he carried inside of it. Three of the treatment staff did an impromptu “intervention” and at one point he almost gave us the bottle. Sadly the vodka was more alluring to him at the time. He kept the bottle.

We knew and liked Leo. He had been in our partial treatment program at least 2 or 3 times before. He demonstrated personal change; helped others with their own drug and alcohol use problems; and usually completed the treatment program. But he repeatedly lapsed or relapsed into active drinking.

He wasn’t angry or belligerent. He didn’t even get upset when we told him if he walked out of the office we would call the local police. He just quietly got up and left—with his daypack. I followed him outside and watched him walk away. The last time I saw him that day he was fifty yards away; slinging his daypack off of his back as he disappeared behind some trees.

Sarah (not her real name) had completed her third or fourth outpatient treatment few months after she turned twenty. This time she had a very good sponsor; had several other women with solid recovery in her sober support system; and seemed to really be trying to remain abstinent. Then we heard that she had announced to everyone that she intended to celebrate her 21st birthday with a pub-crawl. Several people tried to talk her out of this crazy idea, but she wasn’t budging.

I got permission to hold a birthday party for her at the aftercare group I oversee. And then I invited Sarah and anyone in her sober support system that wanted to come. We had a quarter-sized sheet cake and ice cream. Sarah didn’t come, but I saved her a piece of cake and put it in my freezer. About a month later on her birthday, she went on a pub-crawl with her friend. The friend ended up in the hospital with alcohol poisoning. Sarah kept drinking and using drugs for another six or seven months.

When she came back to the Aftercare group, I told her I had a piece of birthday cake for her in my freezer.  When she achieved one year of abstinence, I’d give her the birthday cake. She returned after her one-year anniversary and I gave her the piece of cake. I haven’t heard from her for a few years, but the last news I had was that she was still sober.

Relapse into active drug or alcohol use is, sadly, a common occurrence in recovery. But it doesn’t always have to be. Like the new Tom Cruise science fiction movie, “Edge of Tomorrow,” persistence and repeated battle against addiction can be an opportunity to eventually overcoming this personalized alien invader. But if it’s addiction and not the Mimics that you battle, I suggest you trust in Terence Gorski and not Tom Cruise for your deliverance.

Among the many tools developed by Gorski for this battle is the AWARE (Advance WArning of RElapse) Questionnaire.  It was designed and refined as a measure of the warning signs of relapse. It is simple to use and interpret: the higher the score, the greater the number of relapse warning signs being reported. It was developed through research funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). So it is in the public domain and may be used without specific permission; so long as the proper recognition is given as to its source.  You can read Gorski’s original blog post on the AWARE Questionnaire. And you can download a printer-friendly version of it that I’ve put together here.

Does the frequency of relapse among alcoholics and addicts suggest there is a flaw in abstinence-based treatment and self-help groups?

I have read and used Terence Gorski’s material on relapse and recovery for most of my career as an addictions counselor. I’ve read several of his books and booklets; and I’ve completed many of his online training courses. He has a blog, Terry Gorski’s blog, where he graciously shares much of what he has learned, researched and written over the years. This is one of a series of blog posts based upon the material available on his blog and website.

07/7/14

Never Give Up Hope

Adam’s lead was one of those powerful tales of riches-to-rags-to-riches of drinking and drug use leading to a “low bottom” and then recovery. His bottom included being homeless; losing his job; jail; the whole works. And then he got sober. He always concluded by saying: “And I know that if I ever were to pick up again, I’m never coming back.” He meant what he said. His audience believed him. And when he did pick up, he never came back.

When I was an intern at an outpatient drug and alcohol clinic, I heard the tale of Adam’s relapse. That wasn’t his real name; I don’t think I ever knew it. But Adam’s story was my first lesson in mistaken beliefs about relapse: His mistaken belief about relapse created a self-fulfilling prophecy.

In his booklet Mistaken Beliefs About Relapse, Terence Gorski said: “A mistaken belief is something that you believe to be true and act as if it were true when, in fact, it is false.” Within it, he listed seventeen separate mistaken beliefs. Adam seems to have believed numbers 16 and 17.

Number 16: “Once you begin using it is impossible for you to interrupt your relapse before you have ‘hit bottom’ again.” Many addicts program themselves for a destructive relapse. They believe that it is better to be dead than drunk or high. This seems to be what Adam had buried in the concluding statement to his lead. Once he started, he believed there was no way he could stop. His first bottom was so low, that next was death.

It is true that once you again begin to use addictively, you can never be sure of what is going to happen. But you can have periodic moments of sanity; times where you “regain control of your thinking, your emotions, your memory and your behavior and judgment. . . . It is your responsibility to yourself and those whom you love to get help to interrupt the relapse during these moments of sanity.”

Number 17: “Successful recovery from addiction requires continuous abstinence from the time of the initial commitment to sobriety.” It is a fact that most addicts and alcoholics are not able to maintain permanent abstinence the first time they try. But this is NOT MEANT to be permission to periodically drink or use. There is a difference between a lapse—the initial return to addictive use, and a relapse—the destructive return to loss of control, addictive use.

There are two choices. The person can get help from others to return to abstinence (call your sponsor or others people in your support system; get back into treatment). Then they need to learn from the experience what went wrong; and what they need to do to stay sober in the future. Or they can convince themselves that staying sober is hopeless and continue to use destructively. “If they believe they are hopeless or that they have failed totally because they have lapsed, they will give up and not continue in their efforts to recover.” Sometimes they are lucky enough to have the right set of circumstances re-engage them in treatment or other help. Sometimes they die in their addiction like Adam.

In his blog post on Mistaken Beliefs About Relapse, Gorski discussed what he called the three most common mistaken beliefs about relapse: 1) that it is self-inflicted; 2) that it is an indication of treatment failure; and 3) once relapse occurs the person will never recover. These mistaken beliefs are differently worded than those in his booklet, Mistaken Beliefs About Relapse, but still worth reading and thinking about in their own right.  Adam seems to have fallen prey to the third one.

There are two additional mistaken beliefs I hear a lot: First, that relapse is a part of recovery. Relapse is often a part of someone’s recovery journey, but it doesn’t have to be. Second, some people are “constitutionally incapable” of recovery. Here, Gorski said it best: “The consequence of believing you cannot get well is despair. Without hope there is no motivation to try again and you are condemned to a life of despair.” Never say never. And never give up hope.

What other mistaken beliefs about relapse or recovery have you encountered? 

I have read and used Terence Gorski’s material on relapse and recovery for most of my career as an addictions counselor. I’ve read several of his books and booklets; and I’ve completed many of his online training courses. He has a blog, Terry Gorski’s blog, where he graciously shares much of what he has learned, researched and written over the years. This is one of a series of blog posts based upon the material available on his blog and website.